Dialogues from the ‘Coalface’:DSM‐5 and Emotional Process in a Clinical Setting

Abstract

In this article, we propose that emotional reactivity can influence dialogue around the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the wider issues included in the debate. We explore this emotional process and the impact that it has on our clinical practice, our clients' experiences, our experience of ourselves as clinicians and the ways we work with other professionals. We begin by presenting clinical scenarios, then briefly summarise key ideas from the DSM-5 debate, and draw on Bowen Family Systems Theory to explore a number of ways that emotional reactivity to these ideas can manifest itself in multidisciplinary and collegial relationships. We conclude that it is helpful to increase awareness of our own emotional processes to best avoid becoming reactive to, or dismissive of, alternative paradigms or knowledge bases that may be of use to our clients. We describe a number of principles and ideas that we have found useful in this context and identify ongoing dilemmas in our practice.1 The advent of DSM-5 brings back into focus dilemmas within therapy and mental health around the complexity of different paradigms being used in the best interests of the client and family. 2 The debate is substantial because of far-reaching implications for the whole counselling and mental health field. 3 At the coalface, these dilemmas are not purely theoretical and frequently raise strong feelings around intensely held personal and professional values for the clinician. 4 Emotional reactivity can affect how we see our clients and the options available to them, and the way we collaborate with colleagues in providing care. 5 Applying a theoretical understanding of emotional processes can be useful for reflecting on personal and professional functioning and can provide options for working within a multi-paradigm workplace.The imminent release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has evoked an increased focus on diagnosis, the medical model and the struggle to describe complex human situations adequately. As members of multidisciplinary teams in a publicly funded child and adolescent mental health setting whose overarching frame is systemic 1 , we have watched this discussion with interest. Over time, we have become increasingly aware of the role of emotional responses in this process, both in terms of the impact on the broader debate, in our daily workplace, and within ourselves. This article seeks to explore this issue as it relates to our day-to-day work: with clients and their families/carers; alongside other clinicians in our teams; with the referrers of our clients and other services to which we refer. We have approached this

Therapeutic Use of Fact Sheets in Family Therapy with Children and Adolescents With Functional Somatic Symptoms

“…Anxiety limits the ability to encode and recall information from memory. Some of these effects are mediated via upregulation of stress hormones such as cortisol, which impact negatively on prefrontal cortex functioning (for a review see Kane & Engle, ; Oei, Tollenaar, Elzinga & Spinhoven, ), thereby increasing reactivity in decision‐making processes (Bowen, ; Chambers et al., ; Gilbert, ; Kerr & Bowen, ). We have documented such stress‐related cognitive‐processing difficulties in a cohort of children and adolescents with neurological functional symptoms who presented for treatment to our team (Kozlowska et al., ).…”

“…Specifically, we aim to use language in a way that elicits positive emotional responses, a sense of competence, mastery and hopeful thinking. To optimize therapeutic effects, language interventions include verbal suggestions to enhance hope, positive expectations and the placebo effect; language that fosters a sense of mastery and emphasizes health over disease; language that highlights the therapist's belief that the family already possesses the emotional and practical resources to solve the problem; and language that acknowledges the family's role as part of the treatment team (Benedetti, ,b; Chambers et al., ; Jackson, ; Merton, ; Rosen, ). These implicit effects of language (Jackson, ) are especially ‘important when treating medically unexplained symptoms because the patient's psychological, cognitive, and emotional states have a central role in triggering the illness in the first place’ (Kozlowska et al., , p. 404).…”

Thematic review of family therapy journals in 2013

“…There was also a special issue of the Australian and New Zealand Journal of Family Therapy on DSM‐5 (volume 34 issue 2) with articles on DSM‐5 and evidence‐based family therapy (Strong and Busch, ), medical family therapy (Nobbs, ), narrative informed practice (Simblett, ), emotional processes (Chambers et al . ), first order change (Denton and Bell, ) and self and society (Epstein et al . ).…”

“…There were two editorials in the Journal of Marital and Family Therapy on DSM-5 (Lebow, 2013a;Wamboldt, 2013). There was also a special issue of the Australian and New Zealand Journal of Family Therapy on DSM-5 (volume 34 issue 2) with articles on DSM-5 and evidence-based family therapy (Strong and Busch, 2013), medical family therapy (Nobbs, 2013), narrative informed practice (Simblett, 2013), emotional processes (Chambers et al 2013), first order change (Denton and Bell, 2013) and self and society (Epstein et al 2013). Two emerging themes from these articles were an acknowledgement of the centrality of the DSM to discourse in the international mental health field, and a continuing dissatisfaction among systemic therapists with the DSM classification system, which conceptualizes problems within an individual framework rather than a systemic one.…”

DSM‐5 and Evidence‐Based Family Therapy?

“…To return to Rorty (), what matters in such cases are effective discourses because human language is incapable of representing experience correctly. Some of the anxieties that contributors Chambers, MacDonald and Mikes‐Liu () point to over DSM‐5, for post‐structuralist therapists, relate to how the DSM‐5 could conceivably become therapy's only legitimate language with respect to payment or professional ethics.…”